Shelley Lynn Clark, LICSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

LW61516470 Issued in WA

Practice address

2513 NW 117TH St
Vancouver, WA 98685-3667

Phone

(360) 991-6272

NPI assigned

Nov 7, 2024

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in WA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Social Worker

Education

Other, 2009

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

PeacehealthGroup PAC ID 5890689293, 188 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Ascension Sacred Heart Bay Hospital, Panama City, FL, CCN 100026

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles (1 of 3)

Locations

Networks

• WA PPO C-SNP
• devoted network organization-83621310-88c0-4660-8f8d-b8ea8f4dc04e

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Peacehealth

  • Multi-Specialty Clinic/Center
  • Longview, WA
  • NPI 1720056187
  Medicare reassignment Care Compare group NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Bay County Health System, LLC

  • General Acute Care Hospital
  • Panama City, FL
  • NPI 1720078041
  Care Compare affiliation

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1730937600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1733788800000",
    "number": "1063235992",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2513 NW 117TH ST",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986853667",
            "telephone_number": "360-991-6272"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2513 NW 117TH ST",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986853667",
            "telephone_number": "360-991-6272"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1615 Delaware St",
            "address_purpose": "LOCATION",
            "city": "Longview",
            "state": "WA",
            "postal_code": "986322367",
            "country_code": "US",
            "telephone_number": "360-414-2091",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1718 E Kessler Blvd",
            "address_purpose": "LOCATION",
            "city": "Longview",
            "state": "WA",
            "postal_code": "986321842",
            "country_code": "US",
            "telephone_number": "360-747-5800",
            "fax_number": "360-575-3846",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CLARK",
        "first_name": "SHELLEY",
        "middle_name": "LYNN",
        "credential": "LICSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-11-07",
        "last_updated": "2024-12-10",
        "certification_date": "2024-12-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "WA",
            "license": "LW61516470",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mark W Clark, PSY.D.
• Misty Noel Clark, RN
• Nicolas Clark, CBT70128252
• Richard Clark
• Robert Lee Clark, MS
• Steven Clark, O.D.
• Taylor Rey Clark, LMHC, NCC
• Alison Lee Clarke, DO
• Morgan Miquela Warren Clarkson, MD
• Amanda Nichole Clary

• Clinical Social Worker in Vancouver, WA
• Providers in Vancouver, WA by specialty
• Clinical Social Worker in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 10, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.